DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181501

Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

Ravikumar Tenali, Naveen Kumar Badri, Jithendra Kandati, Munilakshmi Ponugoti

Abstract


Background: TB remains as the one among the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease with 0.4 million with HIV. At least 1 million children become ill with TB each year. Children represent about 10-11% of all TB cases. Having knowledge of the risk factors for tuberculosis infection in children is important to evaluate the level of ongoing transmission of infection and to help adapt activities within national TB control programs. The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.

Methods: The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.

Results: 98 cases of TB were confirmed out of total 628 with a prevalence of 17.07% in the   study with 78 PTB cases and 20 EPTB. Females were more with male to female ratio of 0.7:1.5-9 years was the most common age group in the study. Statistically significant association was found between old history of ATT, HIV positivity, contact with an open case of TB and malnutrition (p value<0.05). TB meningitis was the most common EPTB (10/20 cases) followed by tuberculous lymphadenitis (5/20). 69.39% (68/98 cases) were smear positive, radiologically 59.18% of cases were positive and Tuberculin skin test was positive in 46.94%.

Conclusions: Childhood tuberculosis is a neglected entity in developing countries due to underreporting and difficulties in diagnosis due to variable clinical picture in children. Hence epidemiological surveillance studies in children are required to determine the actual prevalence of pulmonary and extra pulmonary cases of tuberculosis. Increased efforts are required to isolate TB bacilli from body fluids to identify early the childhood cases and manage them to prevent disease burden in the community.


Keywords


Extra pulmonary tuberculosis, HIV, Pulmonary tuberculosis, Tuberculous meningitis, Tuberculin skin test

Full Text:

PDF

References


Global Tuberculosis Report, WHO, Geneva, 2016. Available at http://apps.who.int/iris/bitstream/handle/10665/250441/9789241565394-eng.pdf;jsessionid=278FA33217F54FD3157343BD1893E35A?sequence=1

Dodd PJ, Yuen CM, Sismanidis C, Seddon JA, Jenkins HE. The global burden of tuberculosis mortality in children: a mathematical modelling study. Lancet Glob Health. 2017;5:e8898-e906.

Guidance for national tuberculosis programmes on the management of tuberculosis in children. WHO 2006. Available at http://apps.who.int/medicinedocs/documents/s21535en/s21535en.pdf

Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003;163(9):1009-21.

Tsai KS, Chang HL, Chien ST, Chen KL, Chen KH, Mai MH, Chen KT. Childhood tuberculosis: epidemiology, diagnosis, treatment, and vaccination. Pediatr Neonatol. 2013 Oct; 54(5):295-302.

Technical and operational guidelines for tuberculosis control,” Revised National Tuberculosis Control Programme, Available at http://www.tbcindia.nic.in/pdfs/Technical%20&%20Operational%20guidelines%20for%20TB%20Control.pdf.

International standards for tuberculosis care, 2nd edn. The Hague, Tuberculosis Coalition for Technical Assistance, 2009. Available at http://www.who.int/tb/publications/2006/istc_report.pdf

Agarwal DK, Agarwal KN. Physical growth in Indian affluent children (Birth e 6 years). Indian Pediatr. 1994;31:377e413.

Technical and Operational Guidelines for TB Control in India 2016. https://tbcindia.gov.in/showfile.php?lid=3216.

Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.

Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Enarson DA, Beyers N. The spectrum of Childhood Tuberculosis in a Highly Endemic Area. Int J Tuberc Lung Dis. 2006;10:732-8.

Kabra SK, Lodha R, Seth V. Category based Treatment of Tuberculosis in Children. Indian Pediatr. 2004;41:927-37.

Arora VK, Agarwal SP. Pediatric Tuberculosis: An Experience from LRS Institute of Tuberculosis and Respiratory Disesases. In:Tuberculosis Control. New Delhi: Central TB Division, Ministry of Health and Family Welfare. 2005.

Representatives L. The role of BCG vaccine in the prevention and control of tuberculosis in the United States. A joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 1996;45:1-18.

Baghaie N, Khalilzade S. Extra pulmonary tuberculosis in children: two years study. Pediatric respiratory research centre, Tehran, Iran. Acta Medica Iranica. 2010;48(4):239-43.

Sreeramareddy CT, Ramakrishnareddy N, Shah RK, Baniya R, Swain PK. Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal-a case-series analysis. BMC Pediatr. 2010;10:57.

Bai SS, Devi RL. Clinical spectrum of tuberculosis in BCG vaccinated children. Indian Pediatr. 2002;39:458-62.

Schaaf HS, Marais BJ, Whitelaw A, Hesseling AC, Eley B, Hussey GD, Donald PR. Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases. BMC Infect Dis. 2007;7:140.

Gosai DK, Gosai JB, Shukla OS. Study of clinical profile of childhood extra pulmonary tuberculosis. Int J Res Med Sci. 2014;2:501-5.

Sheth V, Kabra SK, Jain Y, Semwal OP. Study on EPTB. Inst Med Sci. 1994;31:1585-93.

Graham SM, Gie RP, Schaaf HS, Coulter JB, Espinal MA, Beyers N. Childhood tuberculosis: clinical research needs. Int J Tuberc Lung Dis. 2004;8:648-57.

De Villiers RV, Andronikou S, Van de Westhuizen S. Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high-kilovolt radiographs. Australas Radiol. 2004;48:148-53.

Nantongo JM, Wobudeya E, Mupere E, Joloba M, Ssengooba W, Kisembo HN et al. High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda. BMC Pediatr. 2013;13:16.

Vijayasekaran D, Kumar AR, Gowrishankar NC, Nedunchelian K, Sethuraman S. Mantoux and contact positivity in tuberculosis. Indian J Pediatr. 2006;73:989-93.

Kiwanuka JP. Interpretation of tuberculin skin test results in the diagnosis of tuberculosis in children. Afr Health Sci. 2005;5:152-6.